Advertisement

Neuroethics

, Volume 11, Issue 2, pp 167–181 | Cite as

Delusions, Harmful Dysfunctions, and Treatable Conditions

  • Peter Clutton
  • Stephen Gadsby
Original Paper
  • 165 Downloads

Abstract

It has recently been suggested that delusions be conceived of as symptoms on the harmful dysfunction account of disorder: delusions sometimes arise from dysfunction, but can also arise through normal cognition. Much attention has thus been payed to the question of how we can determine whether a delusion arises from dysfunction as opposed to normal cognition. In this paper, we consider another question, one that remains under-explored: which delusions warrant treatment? On the harmful dysfunction account, this question dissociates from the question about dysfunction—there are a broad range of “treatable conditions” beyond mere harmful dysfunctions. As such, many conditions that arise from normal cognition are also eligible for medical intervention. We argue that some delusions that arise from normal cognition may well fall under the banner of treatable conditions. We examine the practical and ethical questions surrounding such treatment, including the issue of coercive and deceptive treatment options.

Keywords

Delusion Treatment Symptom Dysfunction Disorder 

References

  1. 1.
    Wakefield, J.C. 1992. Disorder as harmful dysfunction: a conceptual critique of dsm-iii-r’s definition of mental disorder. Psychological Review 99 (2): 232–247.CrossRefGoogle Scholar
  2. 2.
    Miyazono, K. 2015. Delusions as harmful malfunctioning beliefs. Consciousness and cognition 33: 561–573.CrossRefGoogle Scholar
  3. 3.
    Sakakibara, E. 2016. Irrationality and pathology of beliefs. Neuroethics 9 (2): 147–157.CrossRefGoogle Scholar
  4. 4.
    Cosmides, L., and J. Tooby. 1999. Toward an evolutionary taxonomy of treatable conditions. Journal of Abnormal Psychology 108 (3): 453–464.CrossRefGoogle Scholar
  5. 5.
    Del Giudice, M. 2016. The evolutionary future of psychopathology. Current Opinion in Psychology 7: 44–50.CrossRefGoogle Scholar
  6. 6.
    Varga, S. 2017. Mental disorder between naturalism and normativism. Philosophy Compass 12 (6): 1–9.Google Scholar
  7. 7.
    Wakefield, J.C. 2007. The concept of mental disorder: diagnostic implications of the harmful dysfunction analysis. World Psychiatry 6 (3): 149–156.Google Scholar
  8. 8.
    Bortolotti, L. 2010. Delusions and other irrational beliefs. Oxford: Oxford University Press.Google Scholar
  9. 9.
    Association, A.P, et al. 2013. Diagnostic and statistical manual of mental disorders (DSM-5 R): American Psychiatric Publishers.Google Scholar
  10. 10.
    Coltheart, M. 2017. Confabulation and conversation. Cortex 87: 62–68.CrossRefGoogle Scholar
  11. 11.
    Nisbett, R.E., and T.D. Wilson. 1977. Telling more than we can know: Verbal reports on mental processes. Psychological review 84 (3): 231.CrossRefGoogle Scholar
  12. 12.
    Petrolini, V. 2017. What makes delusions pathological? Philosophical Psychology 30 (4): 502–523.Google Scholar
  13. 13.
    Davies, M., M. Coltheart, R. Langdon, and N. Breen. 2001. Monothematic delusions: Towards a two-factor account. Philosophy, Psychiatry, & Psychology 8 (2): 133–158.CrossRefGoogle Scholar
  14. 14.
    Coltheart, M. 2001. Assumptions and methods in cognitive neuropsychology. In The handbook of cognitive neuropsychology: What deficits reveal about the human mind, ed. Brenda Raap, 3–21. New York: Psychology Press.Google Scholar
  15. 15.
    Chang, H. 2017. Epistemic iteration and natural kinds: Realism and pluralism in taxonomy. In Philosophical Issues in Psychiatry IV: Classification of Psychiatric Illness, eds. Kenneth S. Kendler and Joseph Parnas, 229-245. Oxford: Oxford University Press.Google Scholar
  16. 16.
    McKay, R., and L. Cipolotti. 2007. Attributional style in a case of cotard delusion. Consciousness and cognition 16 (2): 349–359.CrossRefGoogle Scholar
  17. 17.
    Breen, N., D. Caine, M. Coltheart, et al. 2001. Mirrored-self misidentification: Two cases of focal onset dementia. Neurocase 7 (3): 239–254.CrossRefGoogle Scholar
  18. 18.
    Tabb, K., Schaffner, K.F. 2017. Causal pathways, random walks, and tortuous paths: Moving from the descriptive to the etiological in psychiatry. In Philosophical Issues in Psychiatry IV: Classification of Psychiatric Illness, eds. Kenneth S. Kendler and Joseph Parnas, 342-360. Oxford: Oxford University Press.Google Scholar
  19. 19.
    Wakefield, J.C. 1999. Evolutionary Versus Prototype Analyses of the Concept of Disorder. Journal of Abnormal Psychology 108 (3): 374–399.CrossRefGoogle Scholar
  20. 20.
    Clutton, P. Forthcoming. A New Defence of Doxasticism about Delusions: The Cognitive Phenomenological Defence, Mind & Language.Google Scholar
  21. 21.
    Coltheart, M., R. Langdon, and R. McKay. 2011. Delusional belief. Annual review of psychology 62: 271–298.CrossRefGoogle Scholar
  22. 22.
    Sullivan-Bissett, E. 2017. Biological function and epistemic normativity. Philosophical Explorations 20 (1): 94–110.CrossRefGoogle Scholar
  23. 23.
    Bayne, T. 2017. Delusions and the norms of rationality. In Rationality: Constraints and Contexts, eds. T-W Hung & T. Lane, 77-94. London: Elsevier.Google Scholar
  24. 24.
    Fodor, J.A. 2001. The mind doesn’t work that way: The scope and limits of computational psychology. Cambridge: The MIT press.Google Scholar
  25. 25.
    Connors, M.H., Halligan, P.W. 2014. A cognitive account of belief: a tentative road map. Frontiers in psychology 5: 1-14.Google Scholar
  26. 26.
    Nairne, J.S., and J.N. Pandeirada. 2008. Adaptive memory remembering with a stone-age brain. Current Directions in Psychological Science 17 (4): 239–243.CrossRefGoogle Scholar
  27. 27.
    Schacter, D.L. 2012. Adaptive constructive processes and the future of memory. American Psychologist 67 (8): 603.CrossRefGoogle Scholar
  28. 28.
    Conway, M.A. 2005. Memory and the self. Journal of memory and language 53 (4): 594–628.CrossRefGoogle Scholar
  29. 29.
    Klein, S.B., L. Cosmides, J. Tooby, and S. Chance. 2002. Decisions and the evolution of memory: multiple systems, multiple functions. Psychological review 109 (2): 306.CrossRefGoogle Scholar
  30. 30.
    Suddendorf, T., and M.C. Corballis. 2007. The evolution of foresight: What is mental time travel, and is it unique to humans? Behavioral and Brain Sciences 30 (03): 299–313.Google Scholar
  31. 31.
    Ally, B.A., E.P. Hussey, and M.J. Donahue. 2013. A case of hyperthymesia: rethinking the role of the amygdala in autobiographical memory. Neurocase 19 (2): 166–181.CrossRefGoogle Scholar
  32. 32.
    Parker, E.S., L. Cahill, and J.L. McGaugh. 2006. A case of unusual autobiographical remembering. Neurocase 12 (1): 35–49.CrossRefGoogle Scholar
  33. 33.
    Diamond, D.M., and P.R. Zoladz. 2016. Dysfunctional or hyperfunctional? the amygdala in posttraumatic stress disorder is the bull in the evolutionary china shop. Journal of Neuroscience Research 94 (6): 437–444.CrossRefGoogle Scholar
  34. 34.
    Kennair, L.E.O. 2010. The problem of defining psychopathology and challenges to evolutionary psychology theory. In The evolution of personality and individual differences, eds. David M. Buss and Patricia H. Hawley, 451-480. Oxford: Oxford University Press.Google Scholar
  35. 35.
    Nettle, D. 2011. Normality, disorder and evolved function: The case of depression. In Maladapting Minds: Philosophy, Psychiatry, and Evolutionary Theory, eds. Pieter R. Adriaens and Andreas de Block, 198–215. Oxford: Oxford University Press.Google Scholar
  36. 36.
    Wakefield, J.C., K.J. Pottick, and S.A. Kirk. 2002. Should the dsm-iv diagnostic criteria for conduct disorder consider social context? The American journal of psychiatry 159 (3): 380–386.CrossRefGoogle Scholar
  37. 37.
    Wakefield, J.C. 2005. On winking at the facts, and losing one’s hare: value pluralism and the harmful dysfunction analysis. World psychiatry 4 (2): 88–89.Google Scholar
  38. 38.
    Wakefield, J.C. 2005. Sexual dysfunction or pain disorder?: Dyspareunia from the perspective of the harmful dysfunction analysis. Archives of Sexual Behavior 34 (1): 52–57.CrossRefGoogle Scholar
  39. 39.
    Nesse, R.M., Jackson, E.D. 2011. Evolutionary foundations for psychiatric diagnosis: making dsm-v valid. In (eds.) Pieter R. Adriaens and Andreas de Block, Maladapting Minds: Philosophy, Psychiatry, and Evolutionary Theory: 173–197.Google Scholar
  40. 40.
    Bolton, D. 2000. Alternatives to disorder. Philosophy, Psychiatry, & Psychology 7 (2): 141–153.Google Scholar
  41. 41.
    Nesse, R.M. 2001. The smoke detector principle. Annals of the New York Academy of Sciences 935 (1): 75–85.CrossRefGoogle Scholar
  42. 42.
    Giudice, M.D., Ellis, B.J. 2016. Evolutionary foundations of developmental psychopathology. In Developmental psychopathology Volume Two: Developmental Neuroscience, ed. Dante Cicchetti, 1-58. New Jersey: John Wiley & Sons, Inc.Google Scholar
  43. 43.
    Wakefield, J. 2017. Taking people as they are: Evolutionary psychopathology, uncomplicated depression, and distinction between normal and disordered sadness. In The Evolution of Psychopathology, eds. Todd K. Shackelford and Virgil Zeigler-Hill, 37–72. Cham, Switzerland: Springer International Publishing. Google Scholar
  44. 44.
    Bolton, D. 2008. What is mental disorder? An essay in philosophy, science, and values. Oxford: Oxford University Press.CrossRefGoogle Scholar
  45. 45.
    Cooper, R. 2005. Classifying madness: A philosophical examination of the diagnostic and statistical manual of mental disorders. Dordrecht: Springer.Google Scholar
  46. 46.
    Murphy, D. 2006. Psychiatry in the scientific image. Cambridge: The MIT Press.Google Scholar
  47. 47.
    Tsai, S.J., J.P. Hwang, C.H. Yang, and K.M. Liu. 1997. Delusional jealousy in dementia. Journal of Clinical Psychiatry 58 (11): 492–494.CrossRefGoogle Scholar
  48. 48.
    Langdon, R. 2013. Folie à deux and its lessons for two-factor theorists. Mind & Language 28 (1): 72–82.CrossRefGoogle Scholar
  49. 49.
    Arnone, D., A. Patel, and G.M.Y. Tan. 2006. The nosological significance of folie à deux: a review of the literature. Annals of General Psychiatry 5 (1): 11.CrossRefGoogle Scholar
  50. 50.
    Silva, A., M. Ferrari, G. Leong, and G. Penny. 1998. The dangerousness of persons with delusional jealousy. Journal of the American Academy of Psychiatry and the Law Online 26 (4): 607–623.Google Scholar
  51. 51.
    Daulatabad, D., Sonthalia, S., Srivastava, A., Bhattacharya, S.N., Kaul, S., Moyal, D. 2016. Folie a deux and delusional disorder by proxy: an atypical presentation. Australasian Journal of Dermatology 58 (3): e113-e116.Google Scholar
  52. 52.
    Nielssen, O., R. Langdon, and M. Large. 2013. Folie à deux homicide and the two-factor model of delusions. Cognitive neuropsychiatry 18 (5): 390–408.CrossRefGoogle Scholar
  53. 53.
    Reznek, L. 2010. Delusions and the Madness of the Masses. Plymouth: Rowman & Littlefield Publishers, Inc.Google Scholar
  54. 54.
    McKay, R.T., and D.C. Dennett. 2009. The evolution of misbelief. Behavioral and Brain Sciences 32 (06): 493–510.CrossRefGoogle Scholar
  55. 55.
    Bortolotti, L., Sullivan-Bissett, E. 2017. How can false or irrational beliefs be useful? Philosophical Explorations 20 (S1): S1-S3.Google Scholar
  56. 56.
    Bortolotti, L. 2016. Epistemic benefits of elaborated and systematized delusions in schizophrenia. The British Journal for the Philosophy of Science 67 (3): 879–900.CrossRefGoogle Scholar
  57. 57.
    Bortolotti, L. 2015. The epistemic innocence of motivated delusions. Consciousness and cognition 33: 490–499.CrossRefGoogle Scholar
  58. 58.
    Meltzer, H.Y. 2012. Clozapine: balancing safety with superior antipsychotic efficacy. Clinical schizophrenia & related psychoses 6 (3): 134–144.CrossRefGoogle Scholar
  59. 59.
    Lieberman, J.A., T.S. Stroup, J.P. McEvoy, M.S. Swartz, R.A. Rosenheck, D.O. Perkins, R.S. Keefe, S.M. Davis, C.E. Davis, B.D. Lebowitz, J. Severe, and J.K. Hsiao. 2005. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine 353 (12): 1209–1223.CrossRefGoogle Scholar
  60. 60.
    Moritz, S., R. Veckenstedt, S. Randjbar, F. Vitzthum, and T. Woodward. 2011. Antipsychotic treatment beyond antipsychotics: metacognitive intervention for schizophrenia patients improves delusional symptoms. Psychological medicine 41 (09): 1823–1832.CrossRefGoogle Scholar
  61. 61.
    Horwitz, A.V., and J.C. Wakefield. 2012. All we have to fear: Psychiatry's transformation of natural anxieties into mental disorders. New York: Oxford University Press.Google Scholar
  62. 62.
    Horwitz, A.V., and J.C. Wakefield. 2007. The loss of sadness. New York: Oxford University Press.Google Scholar
  63. 63.
    Zachar, P. 2014. Beyond natural kinds: Toward a relevant scientific taxonomy in psychiatry. Kincaid and Sullivan (eds.)(2014): 75–104.Google Scholar
  64. 64.
    Freeman, D., G. Dunn, H. Startup, K. Pugh, J. Cordwell, H. Mander, E. Cernis, G. Wing-ham, K. Shirvell, and D. Kingdon. 2015. Effects of cognitive behaviour therapy for worry on persecutory delusions in patients with psychosis (wit): a parallel, single-blind, randomised controlled trial with a mediation analysis. The Lancet Psychiatry 2 (4): 305–313.CrossRefGoogle Scholar
  65. 65.
    Wakefield, J.C. 2017. Addiction and the Concept of Disorder, Part 2: Is every Mental Disorder a Brain Disorder?. Neuroethics 10 (1): 55-67.Google Scholar
  66. 66.
    Wakefield, J.C. 2013. The DSM-5 debate over the bereavement exclusion: Psychiatric diagnosis and the future of empirically supported treatment. Clinical Psychology Review 33 (7): 825–845.CrossRefGoogle Scholar
  67. 67.
    Wakefield, J.C. 2013. Addiction, the concept of disorder, and pathways to harm: comment on Levy. Frontiers in psychiatry 4: 1-2.Google Scholar
  68. 68.
    Wakefield, J.C., and M.B. First. 2012. Placing symptoms in context: the role of contextual criteria in reducing false positives in Diagnostic and Statistical Manual of Mental Disorders diagnoses. Comprehensive psychiatry 53 (2): 130–139.CrossRefGoogle Scholar
  69. 69.
    Wakefield, J.C. 2005. Disorders versus problems of living in DSM: Rethinking social work’s relationship to psychiatry. In (ed.) Stuart Kirk, Mental disorders in the social environment: Critical perspectives: 83-95.Google Scholar
  70. 70.
    Wakefield, J.C. 2010. False positives in psychiatric diagnosis: implications for human freedom. Theoretical medicine and bioethics 31 (1): 5–17.CrossRefGoogle Scholar
  71. 71.
    Wakefield, J.C. 2008. The perils of dimensionalization: Challenges in distinguishing negative traits from personality disorders. Psychiatric Clinics of North America 31 (3): 379–393.CrossRefGoogle Scholar
  72. 72.
    Benn, P. 2001. Medicine, lies and deceptions. Journal of Medical Ethics 27 (2): 130–134.CrossRefGoogle Scholar
  73. 73.
    Jackson, J. 2002. Truth, trust and medicine. New York: Routledge.Google Scholar
  74. 74.
    Hughes, J.C., Baldwin, C. 2006. Ethical issues in dementia care: making difficult decisions. London: Jessica Kingsley Publishers.Google Scholar
  75. 75.
    Matthes, J., and H. Caples. 2013. Ethical issues in using deception to facilitate rehabilitation for a patient with severe traumatic brain injury. The Journal of head trauma rehabilitation 28 (2): 126–130.CrossRefGoogle Scholar
  76. 76.
    Lewis, M. 2017. Addiction and the brain: development, not disease. Neuroethics 10 (1): 7–18.Google Scholar
  77. 77.
    Wakefield, J.C. 2017. Can the harmful dysfunction analysis explain why addiction is a medical disorder?: Reply to marc lewis. Neuroethics 10 (2): 313–317.Google Scholar
  78. 78.
    Wild, T.C., A.B. Roberts, and E.L. Cooper. 2002. Compulsory substance abuse treatment: An overview of recent findings and issues. European Addiction Research 8 (2): 84–93.CrossRefGoogle Scholar
  79. 79.
    Caplan, A. 2008. Denying autonomy in order to create it: the paradox of forcing treatment upon addicts. Addiction 103 (12): 1919–1921.CrossRefGoogle Scholar
  80. 80.
    Ryan, C.J., G. de Moore, and M. Patfield. 1995. Becoming none but tradesmen: lies, deception and psychotic patients. Journal of medical ethics 21 (2): 72–76.CrossRefGoogle Scholar
  81. 81.
    Teo, D.C., A.M. Abraham, and A.L. Peh. 2017. Folie à deux and Fregoli syndrome with greater severity in the ‘secondary’–A case report. Asian Journal of Psychiatry 25: 254–255.CrossRefGoogle Scholar
  82. 82.
    Series, L. 2015. Relationships, autonomy and legal capacity: Mental capacity and support paradigms. International journal of law and psychiatry 40: 80–91.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  1. 1.Philosophy DepartmentMacquarie UniversitySydneyAustralia
  2. 2.Monash UniversityClaytonAustralia

Personalised recommendations